Wearing of masks, regular washing of hands with soap and social distancing are next to impossible for slum dwellers in India due to practical reasons
Over 65 million or 22 per cent of India’s total population live in urban slums, which are characterised by acute poverty, over-crowding, unhealthy living conditions and a weak urban public health set-up. The three important health behaviours prescribed as preventive measures for Covid-19 by various governments and international health organisations are wearing of masks, regular washing of hands with soap or sanitiser and social distancing. While all these measures are easy to adopt for the middle class and those belonging to the upper strata of society, it is extremely difficult for slum populations to do so due to practical reasons.
According to the latest National Sample Survey (NSS) on drinking water and sanitation, in order to meet their daily water requirement slum dwellers have to walk over 200 metres on an average daily to fetch water. This is because a significant number of slum households depend on public taps/tube wells for drinking water. For instance in States like Uttar Pradesh (UP), West Bengal, Odisha and Chhattisgarh, this percentage ranges from 60 to 82 per cent, while in Karnataka, Delhi, Madhya Pradesh (MP), Andhra Pradesh, Gujarat and Tamil Nadu (TN) it ranges from 24 to 48 per cent.
Also, a large number of households living in slums don’t have private toilets/bathrooms. In States like Odisha, Gujarat, West Bengal and UP respectively, the percentage of households that reported no access to private toilets/bathrooms ranged from 47 to 60 per cent.
Social distancing is also a major problem for slum dwellers as most of them live in one-room tenements and given the national average household size of five members, it is safe to say they have a cheek-by-jowl existence. Washing/sanitising of the hands with soap/sanitiser is an important health hygiene behaviour to tackle the current pandemic crisis. But worryingly, most of the slum households wash their hands only with water before having their meal, forget about using a soap. Given the low levels of education and also household incomes, it is not surprising that health hygiene awareness is very poor among slum households, making them a hotbed of germs and diseases.
One of the major problems that slum dwellers face is the fact that they are not able to get Government facilities/services like water and sanitation, either because of low awareness about Government programmes or because of the fact that they are ineligible for them as they are living in a non-notified slum. Odisha accounts for 72 per cent, Gujarat for 61 per cent, UP for 49.91 per cent and TN for 41.49 per cent of the total slum households who live in non-notified slums. Hence, slum populations are more vulnerable to Covid-19 because of the low provision of basic amenities and poor outreach of municipality services in non-notified slums due to their legal status.
Data from Covid-19India.org as on May 30 show that 10 major cities account for almost 60 per cent of the total confirmed cases of the contagion, namely Mumbai (21.15 per cent), Delhi (10.15 per cent), Ahmedabad (6.15 per cent), Chennai (7.70 per cent), Thane (5.02 per cent), Pune (4.15 per cent), Indore (1.89 per cent), Jaipur (1.08 per cent), Kolkata (1.13 per cent) and Surat (0.86 per cent).
The census 2011 report identified that 13.8 million households — about 64 million people — are located in city slums nationwide. That is 17.4 per cent of all urban households in the country. In fact, in India’s financial capital Mumbai, over 41 per cent of the city’s 12.44 million inhabitants live in slums. It is no wonder then that COVID-19 cases have been rapidly spreading in Mumbai’s Dharavi slum.
Except for Mumbai’s Dharavi, till now we have not had to face a situation where the contagion has spread majorly across the slums in the country. The implications of a Covid-19 outbreak in the urban slums can be disastrous for the urban poor and the public health set-up. In the absence of affordable and quality public healthcare, families living in slums run the risk of deep impoverishment, disease and death. On the other hand, the public health system runs a high risk of getting overrun by patients, only at a scale much worse than the previous swine-flu outbreaks.
Covid-19 has an urban face so far and it is going to stay for a long time. In the short term, the Government must intervene via aggressive administrative measures, starting with affordable or free testing, identification and quarantine of bearers of the virus in slum areas. This has to be followed by the provision of door-to-door drinking water and mobile toilet facilities to avoid crowding around water points or community toilets.
In the medium-term, the Government must decongest cities by developing rapid public transport transit systems and shifting production networks to different parts of the country. In the long-term, the Government must aim for slum-free cities via low cost housing to the poor strata of population and creating urban agglomeration centered on production of high value services such as education, health, information technology and so on.
(Kumar is a Young Professional in the Financial Resource division at NITI Aayog, while Ranjan is a Senior Research Associate at the Institute for Human Development, New Delhi)